Main cause (infants): normal touching and pulling with discovery of ears. This behavior is usually not seen before 4 months of age

Main cause (older children): mild swimmer's ear from: (1) water accumulation during swimming or showers, (2) soap or shampoo retention, or (3) canal irritation from cotton-tipped swabs. Some children are reacting to a piece of earwax in the ear canal.

Not an ear infection: Most younger children (under age 2 or 3) who pull or poke at the ear are unable to confirm or deny the presence of an earache. Dr. Ray Baker examined 100 children with ear-pulling as the chief complaint. The main conclusion was that simple ear-pulling without other symptoms of an illness or infection was never associated with ear infections.

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